Lesselroth BJ, Felder RS, Adams SM, et al. "Design and implementation of a medication reconciliation kiosk: the Automated Patient History Intake Device (APHID)."
Reference
Lesselroth BJ, Felder RS, Adams SM, et al. Design and implementation of a medication reconciliation kiosk: the Automated Patient History Intake Device (APHID). J Am Med Inform Assoc 2009 May-Jun;16(3):300-4.
Abstract
Errors associated with medication documentation account for a substantial fraction of preventable medical errors. Hence, the Joint Commission has called for the adoption of reconciliation strategies at all United States healthcare institutions. Although studies suggest that reconciliation tools can reduce errors, it remains unclear how best to implement systems and processes that are reliable and sensitive to clinical workflow. The authors designed a primary care process that supported reconciliation without compromising clinic efficiency. This manuscript describes the design and implementation of Automated Patient History Intake Device (APHID): ambulatory check-in kiosks that allow patients to review the names, dosage, frequency, and pictures of their medications before their appointment. Medication lists are retrieved from the electronic health record and patient updates are captured and reviewed by providers during the clinic session. Results from the roll-in phase indicate the device is easy for patients to use and integrates well with clinic workflow.
Objective
To describe the Automated Patient History Intake Device (APHID) project design and implementation, review preliminary findings on feasibility, and discuss barriers to adoption encountered by the development team.
Type Clinic
Primary care
Size
Large
Geography
Urban
Other Information
Portland Campus of VA primary care site, employs 35 primary care providers and 45 residents.
Type of Health IT
Patient access system
Type of Health IT Functions
The APHID also runs a medication history module for patients to review their medications. The software enables information to be transferred to the VA's EHR system - Computerized Patient Record System (CPRS). Medical staff review patient-entered information using a specially designed health record note template. The APHID program does not overwrite any data in the health record, nor does it change any medication prescriptions. Staff need to validate the information obtained via the kiosk and update the medical record.
Context or other IT in place
The APHID consists of locally developed software accessed by patients using kiosks. It enables information to be transferred to the VA's EHR system. Medical staff review patient-entered information using a specially designed health record note template.
Workflow-Related Findings
During the feedback sessions, most staff reported that the information provided by APHID helped with the task of history collection. However, many felt that the volume of medications to review and formatting of medication lists made it challenging to quickly identify important discrepancies needing action. Providers also felt overwhelmed with the new responsibility of medication reconciliation and tended to associate the increased workload with the software tool. Some clinicians were also reticent to address discrepancies that fell outside of their content area or prescribing responsibility.
Workflow analysis showed that providers and support staff used a heterogeneous array of ad hoc processes rather than a systematic approach to medication reconciliation. Not all providers reviewed medications and only a few clinics used
paper handouts or memory aids. A small number of providers reviewed medication fill activity or recently expired prescriptions to validate patient histories. Overall, clinics lacked a clearly defined pathway to reconcile medications and most providers believed that associated activities were
unpredictable, redundant, and error-prone.
paper handouts or memory aids. A small number of providers reviewed medication fill activity or recently expired prescriptions to validate patient histories. Overall, clinics lacked a clearly defined pathway to reconcile medications and most providers believed that associated activities were
unpredictable, redundant, and error-prone.
Study Design
Only postintervention (no control group)
Study Participants
Patients being seen at the Portland VA Medical Center, primary care division. Observation of 16 providers and medical assistants to map out clinic throughput, common tasks, and existing reconciliation processes.